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Cancer Pain Management Joanne Chung
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Causes of cancer pain Direct tumour involvement Changes in body structure Anti-cancer therapy, including analgesia Causes unrelated to caner No immediate cause
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Barriers Common misconceptions Organizational aspects Work demands in the clinical area Limitation of prescribing Interprofessional pain education Patient barriers
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Patient barriers Expected to have pain No control over pain Problems with opioid and other analgesics Wait as long as possible for a pain killer Culturally/socially unacceptable Be a good patient...
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Basic Concepts in Pain Management
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Analgesic ladder (WHO, 1998)
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A basic drug list (WHO, 1994)
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An illustration: The WHO analgesic ladder for cancer pain management Analgesics Drug of choiceAlternative Step 1painnon-opioid drug adjuvant aspirin or NSAIDacetaminophen Step 2pain persists or increases weak opioid drug non-opioid drug adjuvant codeineoxycodone Step 3pain persists or increases strong opioid drug non-opioid drug adjuvant morphinemethadone
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Approximate equinalgesic doses of opioid analgesics Parenteral Oral morphine10 mg30 mg buprenorphine0.3 mg0.4 mg codeine-240 mg diamorphine (heroin)5-8 mg20 mg ydromorphone1.5 mg7.5 mg (or PR) levorphanol2 mg4 mg methadone10 mg20 mg oxycodone-30 mg (or PR) pentazocine60 mg180 mg pethidine (merepidine)75 mg300 mg tramadol80 mg120 mg (For information)
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Individual Pain phenomena Total pain Intensity The Lens Model Psychosocial Emotional Pharmacological Functional Beliefs and meanings Cultural lens Independent variables Mediating variables Dependent variable
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A brief description on CCPAT A summated rating scale Inclusion of pain intensity dimension Weights are allocated to each dimension by magnitude scaling Six dimensions (functional, pharmacological, pain beliefs and meanings, psychosocial, emotional and pain intensity) are measured The total scores obtained is the Sum (Total Pain Intensity)
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Gate Control Theory (Carr & Mann, 1998) Distraction Humour Imagery Well being Relaxation Warmth Coolness Massage TENS
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(McGuire, Yarbro & Ferrell, 1995) A multidimensional approach
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Outcome criteria for cancer pain management General impression of ‘ best – worst ’ Satisfaction with pain relief treatment received Average pain score over a week Reduction in analgesic consumption Reduction in emergency room visit
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Effects on activities of daily living Interference with activity Overall general health since treatment Physical findings (e.g. strength of muscles, weight loss) Laboratory results (e.g. blood sugar, cortisol, cytokines)
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Outline Causes for pain Basic concepts in cancer pain management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief methods Outcome measures A cancer pain management (& associated symptom) protocol
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Pain and symptom management algorithm Assessment Assessment Evaluation Evaluation
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